Notice of Disability Benefits Charged or Credited - Form DS-7CR2

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PurposeTo give employers an itemized listing of the disability benefits charged and/or credited to their experience rating account. Each claimant who is/was an employee will be identified by name and Social Security number. (See Form)

UseTo notify employers of amounts of benefits paid, including those amounts to be used in calculating employer F.I.C.A. contributions. This statement will be mailed to you whenever benefit charges or credits are made to your disability experience rating account.

Use by EmployerWhen you receive this form, check each item against your records. The charges made to your account will later be used to determine your contribution rate for the coming fiscal year.

If you find an item you believe is incorrect, or you have any reason to believe the benefits should not have been paid, inform State Plan Operations by mail as directed on the back side of the DS-7CR2. To expedite your response, you may fax your inquiry to (609) 984-4138.

If charges are removed, you will be notified on a subsequent DS-7CR2, the credited amount being indicated by a minus sign (-).

Keep the notice on file as a verification of yearly benefit charges to your disability experience rating account.

The New Jersey Department of Labor and Workforce Development is an equal employment opportunity employer and provides equal opportunity programs.
Auxiliary aids and services are available upon request to assist individuals with disabilities.